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A systematic quality appraisal of clinical practice guidelines for Ménière’s disease using the AGREE II instrument



To systematically appraise clinical practice guidelines for the diagnosis and treatment of Ménière’s disease using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Materials and methods

A systematic literature search was performed to identify guidelines pertaining to the diagnosis and treatment of Ménière’s disease. Data were abstracted from guidelines that met inclusion criteria and appraised by four independent reviewers in the six domains of quality defined by the AGREE II. Domain scores reflecting quality in each domain were calculated. Intraclass correlation coefficients (ICC) were calculated across domains to qualify interrater reliability.


Six guidelines were found to meet inclusion criteria after a systematic literature search. Of the six clinical practice guidelines appraised using the AGREE II, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline received the highest average score, with a mean of 90.7% spanning six quality domains. The guideline with the lowest average score across all domains was the European Position Statement on diagnosis and treatment of Ménière’s disease, receiving an average score across domains of 34.6%. Overall quality scores of clinical practice guidelines for Ménière’s disease had a standard deviation of 21.3%. Two guidelines met the quality threshold of > 60% in at least five domains, qualifying as ‘high’: AAO-HNS and National Institute for Health and Care Excellence. Average ICC across all six domains was 0.87, suggesting near total agreement between reviewers.


Ménière’s disease remains a challenging entity to diagnose and treat; few existing clinical guidelines meet the standards of quality established by the AGREE II appraisal instrument.

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Correspondence to Karthik Rajasekaran.

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Barrette, LX., Xu, K., Suresh, N. et al. A systematic quality appraisal of clinical practice guidelines for Ménière’s disease using the AGREE II instrument. Eur Arch Otorhinolaryngol (2021).

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  • Ménière’s disease
  • Clinical practice guidelines